Human African Trypanosomiasis - A rare case report from India.

A young female patient from Ahmedabad city presented with acute febrile illness and bicytopenia (leukopenia and thrombocytopenia). She returned to India after recent visit to East Africa. Human African Trypanosomiasis (Sleeping sickness) was diagnosed by identification of Trypanosoma brucei rhodesiense in peripheral blood smear. She treated successfully with suramin. In India, we account this as second case of HAT after first report before 18 years in the published literature.

Post Chikungunya Chronic Arthritis: Systemic Inflammatory Status Triggering Acute Coronary Syndrome.

BACKGROUND: Atherosclerosis, inflammation and coronary plaque destabilization are linked to each other. Infections due to various microbes may trigger Acute Coronary Syndrome (ACS) by systemic inflammation cascade. METHODS: We have evaluated the prevalence of Post Chikungunya Chronic Arthritis (PCCA) among 400 consecutive ACS patients (Case group) and compared with control group subjected to elective surgery by the prospective case-control observational study. Cases were excluded if standard criteria of ACS were not satisfied and in the control group if the patient suffered a Myocardial Infarction (MI) within 28 days of elective surgery. PCCA duration more than two years or serum IgM anti-CCP positive patients were also excluded from the case as well as a control group. RESULTS: The case and control groups were similar except, less number of heart failure (O.R.7.3, 95% C.I. 3.3-15.9) and chronic kidney injury patients (O.R. 0.5, 95% C.I. 0.3-0.9) in the elective surgery (control) group. PCCA was present in 24 out of 400 ACS cases and 8 out of 400 control group. Among ACS case-patients, those suffering from PCCA tended to be younger and more often women, with more diabetes, hypertension, chronic kidney injury and high mean CRP. In unadjusted analysis PCCA was three times more common in the case versus control (O.R. 3.0, 95% C.I. 1.4- 6.4); results were indistinguishable after multidiscipline adjustment (O.R. 3.0, 95% C.I. 1.3-6.8). CONCLUSION: PCCA is common among patients with ACS and post-infective systemic inflammation of PCCA may trigger plaque destabilization.

Multi-organ toxicity and death following acute unintentional inhalation of paint thinner fumes.

BACKGROUND: Paint thinners containing a mixture of volatile organic solvents have considerable potential for solvent abuse. Deaths from solvent inhalation have been reported but most of them relate to intentional solvent abuse and occur soon after exposure. Accidental death due to unintentional inhalation of solvent vapors can also occur suddenly but more often, death results from late complications secondary to multi-organ toxicity. Malfunctioning of the cardiorespiratory, renal, and central nervous systems as a result of latent-toxic effects of solvent exposure has received little attention. CASE REPORT: An adult male unintentionally inhaled an excessive amount of paint thinner vapors and immediately developed central nervous system effects, followed by severe cardiorespiratory and renal pathologies that ultimately led to death 11 days after exposure. CONCLUSION: Acute unintentional inhalation of paint thinner fumes resulted in serious multi-organ toxicity and death. This case strongly suggests the need to employ suitable precautionary measures while handling volatile organic solvents in a confined area.

Rehabilitation needs of an inpatient medical oncology unit.

OBJECTIVE: To identify prospectively functional impairments and rehabilitation needs in an acute care medical oncology unit. DESIGN: Prospective cohort study. SETTING: Inpatient medical oncology unit at a Veterans Affairs hospital. PARTICIPANTS: Fifty-five patients admitted over a 6-month period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument, functionally based physical examination, Rehabilitation Needs Assessment, and Recreational Needs Assessment. RESULTS: On admission, the mean FIM total score was 105 out of 126, the FIM motor score was 72 out of 91, and the FIM cognitive score was 34 out of 35. The functionally based physical examination did not generally correlate with scores obtained on the FIM. Forty-eight (87%) patients had rehabilitation needs on admission. Forty-six (84%) patients had rehabilitation needs on discharge. Rehabilitation Needs Assessment on admission showed deconditioning in 42 (76%) patients; mobility impairment in 32 (58%) patients; a significant decrease in range of motion in 23 (42%) patients; deficits in activities of daily living in 12 (22%) patients; a need for recreational therapy in 7 (13%) patients; potential for benefit from patient education in 30 (55%) patients; and a need for modalities, edema control, or wound care in fever than 5% of patients. The most commonly requested recreational activity was reading. CONCLUSIONS: Patients admitted to inpatient medical oncology units have many unmet, remediable rehabilitation needs that may not be recognized by nonrehabilitation physicians and other clinical staff. These findings suggest that assessment of medical oncology patients may be enhanced by consultation with rehabilitation medicine specialists.